Could infantile interactive drawing technique be useful to promote the communication between children with Type-1 diabetes and pediatric team?

Maurizio Vanelli; Alberto Munari; Donata Fabbri; Brunella Iovane; Chiara Scarabello; Icilio Dodi; Carla Mastrorilli; Valentina Fainardi; Dora Di Mauro; Carlo Caffarelli

doi:10.23750/abm.v89i2.7172

Could infantile interactive drawing technique be useful to promote the communication between children with Type-1 diabetes and pediatric team?

Authors

Maurizio Vanelli University Unit on Health systems organization, quality and sustainability, Parma, Italy
Alberto Munari Past-professor, Faculty of Psychology, Geneva University, Switzerland
Donata Fabbri Past-professor, Faculty of Psychology, Geneva University, Switzerland
Brunella Iovane Regional Diabetes Center for children, Parma, Italy
Chiara Scarabello Regional Diabetes Center for children, Parma, Italy
Icilio Dodi Department of General Pediatrics and Emergency, Parma, Italy
Carla Mastrorilli Research Doctorate in Medical Science, Parma, Italy
Valentina Fainardi Research Doctorate in Medical Science, Parma, Italy
Dora Di Mauro Department of Pediatrics, University Children Hospital of Parma , Parma, Italy
Carlo Caffarelli Department of Pediatrics, University Children Hospital of Parma , Parma, Italy

DOI: https://doi.org/10.23750/abm.v89i2.7172

Keywords:

Type 1 diabetes, medical-patient communication, Piagetian psycho-epistemology, infantile drawing, graphic representation, child

Abstract

Aim: to finding what young patients with type-1 diabetes (T1D) knows about their body and also on their illness in perspective to tailor educational interventions to their real ability to understand. Methods: the present study involved 68 children with T1D , 5 to 14 years old with a duration of diabetes ranging from 2 to 6 years and a total HbA1c mean value of 7.96±0.87%. The sample was divided into two age Groups: 28 children 5 to 10 years old were gathered in the Group 1 and 40 teenagers aged from 11 to 14 years in the Group 2. These patients were invited to draw over a white paper using a black pencil “The human body as it is made inside”. Subsequently they were asked to explain: “what is diabetes?” and “where does insulin go?”. According to the methodology of the “interactive drawing”, the interviewer interacted with the children while drawing, forcing them to verbalize the reasons for their choices, to justify their proceeding, to explain their plan and then to explicit their theories. Drawings and replies were classified as Correct, Correct-but-Incomplete and Incorrect. Results: the overall production of correct/correct-but-incomplete drawings was 83.82% vs 16.20% of the incorrect ones. One-hundred of the children who have produced a correct drawing supplied also a correct verbal reply, whereas 100% of the children who have produced an incorrect drawing was unable to supply any information on diabetes or about insulin. Both younger and older subjects who produced a complete-but-incorrect drawing appeared to have misunderstood the action of insulin therapy (only 23% and 17% of correct replies). Children who produced incomplete drawings and provided incorrect replies to the questions about their disease showed also a HbA1c mean value higher (8.36±0.97%) compared to the children who drew and answered correctly (p=0.0023). Conclusions: the operative epistemic approach could represent a promising tool for a health professional team to verify the real understanding acquired by a child about T1D, and to provide pediatrician a guideline to directly communicate with his patient.